BARC Adoption/Foster Application

Begin Again Rescue Co. (BARC) is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of homeless, neglected and abused dogs. BARC is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive necessary medical care, which includes worming, heartworm test, vaccinations, spaying/neutering and microchipping prior to their adoption. Our adoption donation varies between $200 - $450. Puppies require a $100 deposit that is refunded upon dog being altered per our spay/neuter contract.

Current pets in the household must be up to date on vaccinations, on heartworm prevention and be spayed or neutered. We will contact your veternarian and landlord, if applicable. Please provide us with three (3) personal references for you and your family that are not related to you. Please let your references know that we will be contacting them and that they are authorized to communicate with us regarding your application. Must be at least 21 years old to apply.

If you are applying to foster a dog, please check the appropriate box and indicate that in the dog name field.

This questionnaire is designed to help Begin Again Rescue Co. and yourself determine if a specific dog is the right one for you and your household. Begin Again Rescue Co. reserves the right to deny any application based on answers to this questionnaire, interviews, and/or home visits. Dogs will only be placed into appropriate, permanent homes that are the best fit for the dog. Thank you for considering a rescued dog.

Are you interested in adopting or fostering a dog?

AdoptFoster

Name of the dog you are interested in:*

What characteristics about this dog are most interesting to you?*

Why do you want to adopt this dog?*

Your full name:*

Your age:*

Street Address:*

City:*

State*

Zip Code*

Home Phone:*

Area CodePhone Number

Work Phone:

Area CodePhone Number

Cell Phone:

Area CodePhone Number

E-mail:*

Employer:*

Employer Phone:*

Area CodePhone Number

Reference 1 *

First and last name and their relationship to you ie friend, co-worker, neighbor

Reference 1 Phone:*

Area CodePhone Number

Reference 2*

First and last name and their relationship to you ie friend, co-worker, neighbor

Reference 2 Phone:*

Area CodePhone Number

Reference 3*

First and last name and their relationship to you ie friend, co-worker, neighbor

Reference 3 Phone:*

Area CodePhone Number

Are all members of your household in agreement with this adoption?*

YesNoDon't Know

Who will be the pet's primary caregiver?*

Do you live in a*

How long have you lived at this address?*

Do you own or rent?*

OwnRent

If renting, provide name and phone number of landlord:*

Does your landlord allow dogs?*

YesNo

Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone

Do you have a fully fenced yard?*

YesNo

Height and type of fence*

Do you have any of the following?

Underground fenceKennelDog RunPool

Please list the name and age of each person living in your household, including yourself:*

Have your children been around animals before?

YesNo

How active is your family?

Please describe the neighborhood you live in. Ex: town or country, quiet or busy, major roads, traffic, are there a lot of dogs or children, etc.

Does anyone in your home have allergies to dogs or have asthma?*

YesNo

Are you committed to giving this dog a FOREVER home and having the dog stay with you for the remainder of its life even if your circumstances change (i.e. moving, children, etc)?*

YesNo

List any pets you own or have owned in the past five years, names, breeds and their ages*

Where are these animals now?

Are your current pets spayed or neutered?*

YesNo

If no, why not?*

Are your pets current on vaccines?*

YesNo

Are your pets on heartworm prevention?*

YesNo

If no, why not?*

How many of these pets are spayed/neutered?

Have you ever given up a pet?*

YesNo

If yes, what were the circumstances?

Have you adopted from an animal welfare group before?

YesNo

If yes, what organization did you adopt from?

Please provide the name and phone number of your current and/or previous veterinarian or clinic:*

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*

Are you aware of crate training?*

YesNo

Have you ever house-broken a dog or puppy before?*

YesNo

If the dog has an "accident" in your home, what type of correction do you plan to use?*

How many hours each day will your new pet be home alone?*

Where will your new pet sleep at night?*

How will you supervise the dog's outdoor activity?*

Where will your new dog stay when nobody is home?*

What length of time will you allow your new pet to adjust to his new home?*

We recommend a high quality, grain free food. What will you feed your dog?*

How much are you willing to spend for illness or an emergency situation?*

Are you willing to work through your new pet's issues, if any?*

YesNo

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo

Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for?*

YesNo

Do you plan to take an obedience class with your dog?*

YesNoNot sure

If yes, where?

Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?*

YesNo

What circumstances would lead you to give up your new dog?*

If you had to give up your dog, what would you do with him/her?*

In the event you should become unable to care for the dog, what plan is in place and who will take over ownership? Please provide name and contact information.*

Will you allow BARC to do a home visit prior to and after adoption?*

YesNo

Our adoption fee includes at a minimum: spay or neuter, current rabies, DHPP and bordetella vaccines, microchip, deworming, heartworm test and on prevention and can range from $200 - $500. Are you prepared to pay the adoption fee?*

YesNo

How did you find out about Begin Again Rescue Co.?*

Any other comments or information you would like us to know in considering your application? We want to make sure that we help you find the best match for your family.

I hereby authorize the release to BARC my entire vet records for any and all animals that I have or have had. I authorize BARC to conduct a rental and personal reference check, employment reference check and authorize the release of this information.

By submitting this form, I hereby certify that all information provided by me is true and complete. This application is not a binding agreement. Applicant is under no obligation to adopt a dog and Begin Again Rescue Co. is under no obligation to provide a dog to the applicant. Dogs suggested to the applicant based on this application and the subsequent interview and home check may differ from dog(s) listed on this application as Begin Again Rescue Co. may believe that different dogs are a better match for said applicant. All applications are subject to acceptance based on a review process that requires collecting information from references and visiting the applicant's home. All decisions on placing dogs in adoptive and foster homes are based solely on the judgement of the volunteers and board of directors of Begin Again Rescue Co. Applications submitted through this form may be denied for various reasons. Begin Again Rescue Co. reserves the right to make all decisions regarding placement or final disposition of any rescued dog in its care whether in, or being placed in, a foster or adoptive home or other facility. By submitting your completed application to Begin Again Rescue Co. you attest that you have read the above disclaimer and agree to the terms therein. Futhermore you represent that the information you have provided on this form is the truth and to the best of your knowledge and belief. I hereby forever release, discharge and agree to hold harmless and indemnify Begin Again Rescue Co., it's board of directors, and its members, officers and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of a dog sponsored by this organization. I, hereby agree to waive all rights of Subrogation and defense against Begin Again Rescue Co.

I understand that I assume full responsibility for the welfare of this pet from the date of adoption

E-Signature:*

Date

Are your pets on heartworm prevention?*

YesNo

If no, why not?

BARC Adoption/Foster Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information